OBJECTIVES To establish the true prevalence of clinically recognisable and occult obstetric anal sphincter injuries (OASIS). DESIGN Prospective interventional study. SETTING Busy district general hospital. SAMPLE Two hundred and fifty-four women having their first vaginal delivery over a 12-month period were invited. Two hundred and forty-one (95%) participated and 208 (86%) attended foll...

BACKGROUND Chronic anal fissure is a common and painful condition associated with internal anal sphincter hypertonia. Reduction of this hypertonia improves the local blood supply, encouraging fissure healing. Surgical sphincterotomy is very successful at healing these fissures but requires an operation with associated morbidity. Temporary reduction in sphincter tone can be achieved on an outpat...

The improbable marriage of neurophysiology to proctology has proved highly profitable in that the two disciplines have combined to study clinical areas in common, to the mutual benefit of each. The starting point has been anorectal incontinence, but later the emphasis has been extended to include other functional disorders such as constipation. Gowers could be described as the first physiologis...

Manometric recordings of lower bowel motility have been difficult to interpret because 1) this segment frequently displays no spontaneous activity for periods as long as 6 hours (1), 2) attempts to stimulate normal activity have been met with inconsistent results (2-4), and 3) the activity observed has not been clearly related to this segment's primary function, defecation (2-7). We have descri...

Two female patients aged 62 and 44 years with progressive systemic sclerosis and passive faecal incontinence are described. Both had the typical gut motility disorders of dysphagia, heartburn, and constipation. Anorectal physiology tests showed a low resting pressure in both and an absent rectoanal inhibitory reflex in one. In both patients anal endosonography showed a thin internal anal sphinc...

The aim of this study was to determine if nitric oxide (NO) is the non-adrenergic, non-cholinergic neurotransmitter, released by enteric inhibitory nerves, which mediates relaxation of the human internal anal sphincter. Isolated muscle strips were mounted for isometric tension recording in superfusion organ baths. Sodium nitroprusside, an exogenous donor of NO, relaxed the strips in a concentra...

BACKGROUND Internal anal sphincter hypertonicity with nonrelaxation can cause persistent constipation and obstructive symptoms in children after surgery for Hirschsprung's disease. Intractable symptoms traditionally have been treated with anal myectomy, which may be ineffective or complicated by long-term incontinence. The authors evaluated prospectively the use of intrasphincteric botulinum to...

PURPOSE To compare endoanal ultrasonography (US), endoanal magnetic resonance (MR) imaging, and phased-array MR imaging for anal sphincter muscle measurement. MATERIALS AND METHODS Sixty healthy volunteers underwent 1.5-T phased-array MR, endoanal MR, and endoanal US examinations. Sphincter muscle thicknesses were measured. Measurement reliability was analyzed, and correlations among the imag...

AIM Structural anal sphincter damage may be secondary to obstetric anal sphincter injury, perineal trauma or anorectal surgery. We reviewed the spectrum of anal sphincter injuries and their outcomes in a tertiary care colorectal unit. METHODS Data of patients who underwent anal sphincter repair between 2004 and 2008 were analyzed retrospectively. Outcomes were compared with respect to etiolog...

The mechanics of defecation and fecal continence are poorly understood. Valvular theories for continence 2 rely on raised intra-abdominal pressure to force the anterior wall of the rectum downwards to close off the anorectal junction. Such theories are not consistent with EMG and radiological data which suggest a striated muscle sphincteric mechanism.3 It has been demonstrated that puborectalis...